HomeMy WebLinkAboutPermit Building 1989-9-13
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) 71 NZ6SP_E3CT6gl ON LINE r 1_ '^, 1\ ",i. CITY Ur SPRINGflE~D
7 '-/V\'" ~~ COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Job Address '2//0 M.#fi'=~ ;?P. Reat ~
Legal Description /?-.?7-::Z~-::2 ~, /"""" _ /?>/:. /""7 _ liater Heater
d . Range
q~ 7 .~"""o ' Valut of Hark:
Owner. J!ILL-M.4./Y h07"c7?:r/~S /Y. jA/. t/q 5'~!.~O .1
A_I.I BulldinQ Pennit Info: Describe Work{ Le. I Build Single
......rcss '9d.c::> N~ Z;h'?~nLlWD' /-"5. ~. Phone Familv Residence .Hith Attached GaraQe'
.-n 2Biff-'f/11 ./' .,/ ..-:::
r'bP7'/.4,...-D ,&~, '972/7 ~r:?vC'T 7;7:1?tV.:::Tt-';j'~'L ...;>~~
Construction Lender ' ~7? ~/"7cE'"7-?=/Al-L Lc-__~~ ::;;?#-C€
Address rho"e 1~""/7r4;'RP~7~~ 5'GjP~~
Ul:.:ill.ir~ Itlm lname} laddress1 {iics. no. \ (@xnirf'~;) (ohone no.
~/7Y' ;>./"Y. III '~YG
Primary E#YAAA/N-R"Ld-",-.AlSGl?'-<. 7;'c., l!e>E//ZA'hZ>V'/3'. ~7=?
. ~PI'r''''':>. w. ':::~.if'86'rT"jlV~ :5"'/r~:z.C:>1
StructuralR.4: W~ C~7.? '!::kl!'7"Lt!Jf-7?, ,,,?,??, 979&>/
, -::?cc:>7 5.~~.?'-M. ::57.
Electrical MF/A. /A/C _ P",,;t;'?;!'#-""?"Z>. ~7'? '97:Z/~
. I
Hechanical 29.......",E ~ fi;1?_v~.
CONTRACTORS (namel
General LL-Pn:' #wR,L f #-z....-c-., 7'37 /7#Y/f$F7 -::>;0;-
CO~1,/IND. FEEDERS
Install/alter/relocate
~i~t~ih_ fpprlpr~
Of amps.
Z; '8'F ~"""'/Yo-?> . '5'9--' ~
~ ~V~y lEa <:;7}'f', ~'
//~<:> Mu :8'€ ff'~,. ISSUANCE OF PFRlm
TOTAL CHARGES 557,;>0 TOTAL CHARGES 'is:'''''' TOTAL CHARGES ~ Ai . /$':' '""'"
WIIERE STATE L\li REQUIRES that the Electrical work be done by an..Electrical Contractor. the electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED the completed aprlication for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of OreC)on pertaining to the work described herein. and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon. and that
onlY. subcontractors and employees who are in, compliance with ORS m1.05~Will be used on 'this Pjfject.
1~A1.1E(please prlnt)b FR T W Al U=<.., SIGNATURE ~ L, )~ DAT8::....IZ<?)-f!fl
FOP. OEFICE USE OIlLY
Sq. Ftg, llain /92.::::'
Sq. Ftg. Access
;5>- 2. Sq, Ftg, Other
Plumbina
Electrical
~lechanical
PLUIIB IrlG
NO,
Each single fixture
Relocated building
(new fix, additional)
S.F. Residence
(1 bath]
Duplex (1 bath) each
Additional bath
:z Water service
-;;,/ Sewer
Storm Sewer
.
INFORlIATION LINE
726-3753
Sq. Ftg, 11ain /'??C>
~q: Ftg. Access,
Sq, Ftg, Other
~lew__Add__Alter--Yep,
Fence Demo Change/Use
Other -- --
~
~
N
N
'.j
6''1''(- '(222
7:;>3'-oSS~
23'/-&P51./8
{addr~ss1
Ilics, no,l
y /7?/-// /r>'Y-1,~.t.?/A1-'
-'"
--V
(ohonl'~ no.1
(exrd res)
/2~6\g.:?&- q'L,/V9'
ELECTRICAL
FEE . CllIlBliL Jjn
Residence of
SQ, FT,
./ New circuits alts.
or extensions
-:2.i~ />?~"" CE
SERVICES
Temporary Construction
6. ;>P Change in existing
rP'i 1 ~p"n,.p
'20,4'& multifamily, comm. or
Indu..trial
I Of !,?p amps,
MECHANICAL
<<< r~AIU~s:' NO <<< .rHARG.E..
I furnace/burner to
BTU's 6.--
Floor furnace
;22.52; and vent
Recessed wall
Soace h~~tpr ~nd vpnt
::?z.:i: '
Appliance vent
5eD<1 r~ t~
Stationary evap.
rnnl~r
Vent fan wi th
s.ingle duct
Vent system apart from
hea ti nq or A. c.
Mechanical exhaust
hood ~nd duct
Wood stove/heater
(./ ~"""". hh/Y?,
;:;? ~ .....
x2/,//
Value </,t)~/.c;.c>
Zone CC:::
Fire Zone
Flood Plain
Type/Canst. :Y-~ ~/? Units
Bedrooms Occy load
Stories ,r' Occy Group
x
Value
Value
BUILDING PERlilT
Charges and ....,
Surcharges J-
PLUI1BING PERMIT
Charges and I'
Surcharges. '::>
x
Plan Ck. Comrn/lnd
__:?_~<::"~='___ Ml/Bldo P,or Foo
, Plan Ck, Res
,. "2./3 30t/Bldo Per Fee
--::7~ .-=-0. Fence
---~~-----
/.75 Demo
(iJ
/S? ';;3
TOTAL VALUATION
Systems Development "
Charqe tl.5%) .'
/,-
r:;o 7. g:2:
ELECTRICAL PERrm .Sidewalk
Charges and U ------------
Surcharges -\ A/C Paving
MECHANICAL PERMIT
Charges and .'" __
Surcharges fJ'V
~r
Total Comb, Permit
~07. /;J
____c.::?:.'_::__ Curb Cut
-7S-
TOTAL
lotJ 72. ?B
.
liP-- -rtf I '" J rltp
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax lot 100, lane County Map Reference
II UJ 43
2. exam~le- Lot I, Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilinqlor forced air qas
2. exa~le- waterheater/electricalJor solar
E. Square footage or valuation. etc. - .
I. example, 1250 SQ, foot house, SOD sQ. foot garage
2. exa~le- if new project,. check new - if addition,
check add, etc. '
F. Building pennit information:
1. example - construct single family house with an .
attached garage
2. exa~le - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No, Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the ,abbreviated schedules you should consult the
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.not authorized
to sign the electrical label. ---
III, Applicant to sign and date ,
Whenever possible, the initial application will be used as .
a worksheet only, Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture. .
IV. Fees and Charges
Plan check fees are due and payable at the time of the. .
application. and no plans will be processed until these" "'"" .
fees are paid. All other fees and charges are due and
payable when the permit is issued.
,.... \
V. FOR OFFICE USE ONLY
. ."
Permit Clerk
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name Lv-?f'h'6 ?z~~~~ Signature~?~.:.~ date ~--:::?c>-B9
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